Internet social support groups as moral agents: the ethical dynamics of HIV+ status disclosure

Responsibility in Medical Sociology: A Second, Reflexive Look

Personal responsibility has emerged as an important element in many countries' public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such "responsibilization" as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual's perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.

Lay participation with medical expertise in online self-care practices: Social knowledge (co)production in the Running Mania injury forum

Recent literature on the public understanding of science has focused on replacing the deficit model of public communication in which experts disseminate information with one that encourages public participation and dialogue. Situated within this call for increased participation, this study looks at self-care practices in which medical expertise is not passively consumed by the layperson, but shared and (re)produced through arenas of lay practice. This collective knowledge production is facilitated by the online environment, which provides access to mediated medical knowledge and the ability to form communities in which users can negotiate this expertise and share their experiences. The laypersons examined here are members of the Canadian online collective, Running Mania, highlighting how this negotiation of expertise occurs in a "wellness" community. Drawing from member interviews and website observations of the site's injury forum, the study examines collective injury management using two dominant theoretical discourses surrounding lay knowledge and participation in medical expertise: the lay expert whose knowledge arises from experience and the expert patient whose knowledge base parallels dominant biomedical discourse. Using the coproduction model and the related concepts of tinkering and logic of care from material semiotics, the research examines how these knowledge forms articulate to produce an intermediary discourse unique to this collective's articulation of running and caring practices, a discourse that is enacted in individuals' embodied negotiation of these multiple forms of medical expertise. It suggests that the logic of care has the potential to bridge the expert/lay boundary since the need for persistent, attentive tinkering applies across epistemological divides: in "good" care practices, multiple expertises are needed, both expert and lay, to hold the body together.

Construction and Validation of a Self-report Subjective Emptiness Scale

Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems (n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.

It doesn’t make sense, but we do: framing disease in an online metastatic breast cancer support community

Using Weick’s sensemaking as a conceptual framework to investigate online discussions between members of a Facebook group of metastatic breast cancer patients, and using thematic analysis to examine textual threads between group members, this research examines participants’ framing of cancer survivorship. Participants in peer-to-peer disease support groups, which are not led by medical experts, communicate differently among themselves in order to cope with chronic and terminal illness. Perceptions of survivorship of late stage patients versus early stage patients differ for a variety of reasons, with late stage patients understanding their illness trajectory more often as chronic and declining. This analysis identified three properties of sensemaking used by members to manage their disease: identity, retrospective, and enactment. Results indicate that peer-to-peer online support group communication engenders distinct framing logics that members draw upon for group support as they manage a chronic and terminal disease.

Online Peer-to-Peer Communities in the Daily Lives of People With Chronic Illness: A Qualitative Systematic Review

This qualitative systematic review investigated how individuals with chronic illness experience online peer-to-peer support and how their experiences influence daily life with illness. Selected studies were appraised by quality criteria focused upon research questions and study design, participant selection, methods of data collection, and methods of analysis. Four themes were identified: (a) illness-associated identity work, (b) social support and connectivity, (c) experiential knowledge sharing, and (d) collective voice and mobilization. Findings indicate that online peer-to-peer communities provide a supportive space for daily self-care related to chronic illness. Online communities provided a valued space to strengthen social ties and exchange knowledge that supported offline ties and patient-doctor relationships. Individuals used online communities to exchange experiential knowledge about everyday life with illness. This type of knowledge was perceived as extending far beyond medical care. Online communities were also used to mobilize and raise collective awareness about illness-specific concerns.

"I Always Vet Things": Navigating Privacy and the Presentation of Self on Health Discussion Boards Among Individuals with Long-Term Conditions

Background

The ethics of research into online communities is a long-debated issue, with many researchers arguing that open-access discussion groups are publically accessible data and do not require informed consent from participants for their use for research purposes. However, it has been suggested that there is a discrepancy between the perceived and actual privacy of user-generated online content by community members.

Objective

There has been very little research regarding how privacy is experienced and enacted online. The objective of this study is to address this gap by qualitatively exploring the expectations of privacy on Internet forums among individuals with long-term conditions.

Methods

Semistructured interviews were conducted with 20 participants with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and 21 participants with type 1 and 2 diabetes mellitus, and were analyzed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups.

Results

The findings indicate that privacy online is a nebulous concept. Rather than individuals drawing a clear-cut distinction between what they would and would not be comfortable sharing online, it was evident that these situations were contextually dependent and related to a number of unique and individual factors.

Conclusions

Interviewees were seen to carefully manage how they presented themselves on forums, filtering and selecting the information that they shared about themselves in order to develop and maintain a particular online persona, while maintaining and preserving an acceptable level of privacy.

Confidentiality, anonymity and amnesty for midwives in distress seeking online support - Ethical?

BACKGROUND

Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support.

RESEARCH DESIGN

Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach.

FINDINGS

Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified.

DISCUSSION

Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery.

CONCLUSION

In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.

Using social media for support and feedback by mental health service users: thematic analysis of a twitter conversation

BACKGROUND

Internet based social media websites represent a growing space for interpersonal interaction. Research has been conducted in relation to the potential role of social media in the support of individuals with physical health conditions. However, limited research exists exploring such utilisation by individuals with experience of mental health problems. It could be proposed that access to wider support networks and knowledge could be beneficial for all users, although this positive interpretation has been challenged. The present study focusses on a specific discussion as a case study to assess the role of the website www.twitter.com as a medium for interpersonal communication by individuals with experience of mental disorder and possible source of feedback to mental health service providers.

METHOD

An electronic search was performed to identify material contributing to an online conversation entitled #dearmentalhealthprofessionals. Output from the search strategy was combined in such a way that repeated material was eliminated and all individual material anonymised. The remaining textual material was reviewed and combined in a thematic analysis to identify common themes of discussion.

RESULTS

515 unique communications were identified relating to the specified conversation. The majority of the material related to four overarching thematic headings: The impact of diagnosis on personal identity and as a facilitator for accessing care; Balance of power between professional and service user; Therapeutic relationship and developing professional communication; and Support provision through medication, crisis planning, service provision and the wider society. Remaining material was identified as being direct expression of thanks, self-referential in its content relating to the on-going conversation or providing a link to external resources and further discussion.

CONCLUSIONS

The present study demonstrates the utility of online social media as both a discursive space in which individuals with experience of mental disorder may share information and develop understanding, and a medium of feedback to mental health service providers. Further research is required to establish potential individual benefit from the utilisation of such networks, its suitability as a means of service provision feedback and the potential role for, and user acceptability of, mental health service providers operating within the space.

Sharing experiences and social support requests in an Internet forum for patients with systemic lupus erythematosus

Internet forums represent a useful but understudied resource to understand psychosocial aspects of living with systemic lupus erythematosus. This study was aimed to describe the demand/supply of social support through the Internet in relation with the description of personal illness experiences. All the posts (118) from an Italian forum for systemic lupus erythematosus patients were collected and analyzed combining qualitative content analysis with statistical textual analysis. The results showed different purposes for posts: starting new relationships, seeking information, receiving emotional support, and giving a contribution. Lexical analysis identified three ways of describing patients' experiences. Discussion focuses on the relationship between the requested/offered support and systemic lupus erythematosus experiences.

Online networks as a venue for social support: a qualitative study of married bisexual men in Taiwan

Online networks have become a critical venue for bisexual males to communicate with each other and solicit social support. This study reports qualitative feedback gathered from 12 married Taiwanese bisexual men about online social support in their daily lives. The analysis of interviews reveal that online social support provides participants with opportunities to screen potential friends, participate in the bisexual virtual community, come out and release stress, and look for romance. Apparently, for married bisexual men in Taiwan, the Internet offers an opportunity to anonymously manage sexual identity and solicit social support among other bisexuals.

Blogging for weight loss: personal accountability, writing selves, and the weight-loss blogosphere

Body weight is a key concern in contemporary society, with large proportions of the population attempting to control their weight. However, losing weight and maintaining weight loss is notoriously difficult, and new strategies for weight loss attract significant interest. Writing about experiences of weight loss in online journals, or blogging, has recently expanded rapidly. Weight-loss bloggers typically write about daily successes and failures, report calorie consumption and exercise output, and post photographs of their changing bodies. Many bloggers openly court the surveillance of blog readers as a motivation for accountability to their weight-loss goals. Drawing from a sample of weight-loss blogs authored by women, we explore three issues arising from this practice of disclosing a conventionally private activity within an online public domain. First, we examine motivations for blogging, focusing on accountability. Secondly, we consider the online construction of self, exploring how weight-loss bloggers negotiate discourses around fatness, and rework selves as their bodies transform. Finally, we consider the communities of interest that form around weight-loss blogs. This 'blogosphere' provides mutual support for weight loss. However, participating in online social spaces is complicated and bloggers must carefully manage issues of privacy and disclosure.

Public claims about automatic external defibrillators: an online consumer opinions study

BACKGROUND

Patients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs), designed for the treatment of Sudden Cardiac Arrest (SCA), have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context.

METHODS

We carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM).

RESULTS

Five high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected within the existing TAM.

CONCLUSIONS

The value, credibility and implications of the findings of this study are considered within the context of existing AED research, and related to technology acceptance theory. From a methodological perspective, this study demonstrates the potential value of online consumer reviews as a novel data source for exploring the parameters of public debate relating to emerging health care technologies.

Patients' perspectives on self-testing of oral anticoagulation therapy: content analysis of patients' internet blogs

BACKGROUND

Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.

METHODS

Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.

RESULTS

The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.

CONCLUSIONS

Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.

Interviews and internet forums: a comparison of two sources of qualitative data

We report a comparative keyword analysis of interviews and Internet postings involving people with breast and prostate cancer and discussion of sexual health. Interviewees produce retrospective accounts, their content guided by interviewers' questions, which might elicit rich biographical and contextual details. Internet exchanges concern participants' current experiences and contain detailed accounts of disease processes, medical procedures, bodily processes, and, in the case of sexual health, sexual practices. They are used by participants to exchange information and support in a relatively anonymous context. Because of the ease with which large amounts of such archived Internet materials can be accessed and analyzed, this source has considerable potential for direct observation of illness experiences, although some disadvantages also exist. This reverses an earlier situation where observational research was more laborious than qualitative interviews. Observational material for research purposes is, through the Internet, now easy to obtain and produces naturalistic data.

Living with HIV/AIDS and Use of Online Support Groups

The present study explores the association between online support group use and health status, coping and social support among 640 individuals with HIV/AIDS. Results suggested that frequent users tended to be female, younger, single, and in a more advanced disease stage. After controlling for covariates, frequent users reported poorer health than non-users. In addition, both frequent and infrequent users scored higher in planning, active coping, instrumental support and emotional support coping from the brief COPE. No significant difference was found for social support. Our results suggest that online support groups may potentially offer some benefits for those living with HIV/AIDS.

‘Do you feel sorry for him?’: Gift relations in an HIV/AIDS on-line support forum

Sociologists have debated whether meaningful emotional relationships can be formed on-line. Drawing on Mauss’ concept of the gift, I explore how caregivers who participate in Hope, an on-line support forum dedicated to HIV/AIDS, incorporate moral percepts and understandings about ethics into their caregiving experiences. Their intense discussions on the essence of familial loyalties give rise to emotionally vibrant, empathic communities in which a socio-emotional economy is formulated. Can the Internet act as a moral space? How are concepts such as reciprocity, obligation, and commitment talked about and practiced in an on-line forum that exists in the ever present?

The dual role of the action researcher

This article aims to provide more insight into advantages and challenges of conducting action research with the intention to improve health care. Action research is distinctive in the sense that the researcher has a dual role as both researcher and implementer of the program studied. The article is based on two Norwegian action-oriented studies that aimed to explore the potential role of online self-help groups for breast cancer patients and adolescents with mentally ill parents respectively. We argue that action research can contribute both to the generation of knowledge, as well as a greater sense of ownership to the program among those who are intended to use it. Nonetheless, a potential conflict between the researcher's pursuit of data, and ethical considerations became apparent in the contexts studied here. Bearing these challenges in mind, we still conclude that action research offers an important contribution for the further development of health care services.

A space for suffering? Communicating breast cancer in an online self-help context

In this article, I explore the communication in an online self-help group for Norwegian women with breast cancer, aiming to add further knowledge to the question of whether the online context functions as a "liberating realm" for alternative discourses about illness. My analysis is conducted within an action-oriented framework and is based on participant observation of the online communication and qualitative interviews of women who participated in the group. Based on the analysis, I argue that proposals of a replication of dominating offline discourses in online communication are affirmed. More precisely, I argue that a "socially desirable" story about the cancer "hero" was further circulated in this online context, and that experiences of resignation and meaninglessness were not woven into the communication. Offering some reflections on this process, I suggest that it has active and voluntary aspects that need attention in further research.

Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another's data

BACKGROUND

This project investigates the ways in which patients respond to the shared use of what is often considered private information: personal health data. There is a growing demand for patient access to personal health records. The predominant model for this record is a repository of all clinically relevant health information kept securely and viewed privately by patients and their health care providers. While this type of record does seem to have beneficial effects for the patient-physician relationship, the complexity and novelty of these data coupled with the lack of research in this area means the utility of personal health information for the primary stakeholders-the patients-is not well documented or understood.

OBJECTIVE

PatientsLikeMe is an online community built to support information exchange between patients. The site provides customized disease-specific outcome and visualization tools to help patients understand and share information about their condition. We begin this paper by describing the components and design of the online community. We then identify and analyze how users of this platform reference personal health information within patient-to-patient dialogues.

METHODS

Patients diagnosed with amyotrophic lateral sclerosis (ALS) post data on their current treatments, symptoms, and outcomes. These data are displayed graphically within personal health profiles and are reflected in composite community-level symptom and treatment reports. Users review and discuss these data within the Forum, private messaging, and comments posted on each other's profiles. We analyzed member communications that referenced individual-level personal health data to determine how patient peers use personal health information within patient-to-patient exchanges.

RESULTS

Qualitative analysis of a sample of 123 comments (about 2% of the total) posted within the community revealed a variety of commenting and questioning behaviors by patient members. Members referenced data to locate others with particular experiences to answer specific health-related questions, to proffer personally acquired disease-management knowledge to those most likely to benefit from it, and to foster and solidify relationships based on shared concerns.

CONCLUSIONS

Few studies examine the use of personal health information by patients themselves. This project suggests how patients who choose to explicitly share health data within a community may benefit from the process, helping them engage in dialogues that may inform disease self-management. We recommend that future designs make each patient's health information as clear as possible, automate matching of people with similar conditions and using similar treatments, and integrate data into online platforms for health conversations.